There is a lot of miscommunication out there when it comes to gluten.

What should be a red flag for anyone wondering about how gluten might be affecting their health is the advice that 1. gluten is not a problem unless you have celiac disease OR 2. everyone should be eating a gluten-free diet in order to cure whatever ails you. Both of these blanket recommendations do not take the individual into account and neither are accurate.

So is it just a fad, or is there some merit and scientific evidence pointing to why gluten is not your friend? I'm hoping this article will bring a little more clarity to this question for you.

Let's start with a little education. Here is a summary of the 5 W's of gluten:

Who? Gluten was not always a bad guy. In Europe most people can still tolerate him, but on this side of the ocean we often don't get along with him, whether we know it or not. Only 1% of the population has celiac disease but up to 49% of the population have the genes for gluten intolerance.

What? Gluten is a protein found in wheat, barley and rye that’s made up of gliadin and glutenin. Gliadin is what’s causing the allergy in celiac and gluten sensitive people.

Where? Besides being in some of our favourite foods like bread, pasta, crackers, and cookies, it’s also in unsuspecting foods like sauces and beverages! That is because wheat is a cash crop and a cheap filler!

When? Wheat has evolved over the last several thousand years but likely became poorly tolerated over the last century when it was naturally hybridized, genetically modified, and sprayed with chemicals like glycophosphate. Hint: Europeans do not have the same regulations around glycophosphate or foods that are genetically modified.

Why? It wasn’t always a problem for us to eat, but we weren’t really meant to mass produce and consume it in the quantities we do now. The more exposure we have to these modified gluten proteins, the more likely our genes for gluten intolerance get turned on. This is what we call an epigenetic effect.

Research by Dr. Alessio Fasano discovered that gluten can release zonulin in the gut. Zonulin is an enzyme that contributes to something called leaky gut syndrome. Leaky gut is an opening between cells which allows toxins, food proteins and organisms to get into the bloodstream. Our immune system reacts to these foreign particles and this starts the cascade of chronic inflammation. Chronic inflammation is the root of many chronic disease processes in the body.

Need to dive a little deeper into the science?

You can start with these scientific publications:

1. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease Uhde M, et al. Gut 2016;0:1–8. doi:10.1136/gutjnl-2016-311964.
2. Drago, S.; El Asmar, R.; Di Pierro, M.; Grazia Clemente, M.; Tripathi, A.; Sapone, A.; Thakar, M.; Iacono, G.; Carroccio, A.; D'Agate, C.; et al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand. J. Gastroenterol. 2006, 41, 408–419.

Now that we have established the scientific possibility that almost half of the North American population would be wise to break up with gluten, how do you know if you are one of them?

First it needs to be determined whether or not you have celiac disease or non-celiac gluten sensitivity.

This can be done very accurately through a blood test and then confirmed by the diagnostic gold standard of an intestinal biopsy. If positive, you have celiac disease. This means any time you eat gluten your body will have an autoimmune reaction. Your immune system will start destroying your intestinal villi because it thinks your own intestinal tissue is a foreign invader. You will need to avoid all gluten for the rest of your life. Common symptoms of celiac disease are diarrhea, abdominal pain, weight loss and malabsorption.

If negative, you still have to determine if you have a sensitivity.

Non-celiac gluten sensitivity diagnosis does not have same accuracy. Nor does it have the same symptoms. Patients could have symptoms ranging from bloating to chronic headaches to eczema.

Currently the most commonly used and widely accepted test by naturopathic doctors and other functional medicine practitioners is an IgG blood test. To read more information on this test you can read the patient information sheet from the lab we currently use at the office: IgG food allergy test

Other practitioners will forgo any testing and rely on only an elimination diet. The downside of this is you are only getting subjective information and the person could have more than one sensitivity at the same time. This quite common if someone has a leaky gut.

You can also test zonulin levels but remember this test will only tell you if you have leaky gut syndrome, not whether or not you are gluten-intolerant. There are other common foods that can trigger a leaky gut.

In summary, the way I approach a case (and whether someone really needs to break up with gluten) is this:

1. Does this person have celiac disease?
2. Does this person have a leaky gut?
3. Is gluten one of the triggers for their leaky gut?

Now I would love to hear from you! What is one thing that has confused you about gluten? Leave a comment below and I'll be back next week with another edition of Doctor as Teacher Tuesday!"